RESEARCH ON ACTIVE MANAGEMENT OF THE THIRD STAGE AT CAESAREAN SECTION: SUBLINGUAL MISOPROSTOL VS INTRAVENOUS OXYTOCIN

Abstract

OBJECTIVE
To compare the effectiveness of sublingual misoprostol administered immediately
after delivery of the neonate at caesarean section, with intravenous oxytocin in
prevention of uterine atony and thereby reducing blood loss at caesarean
section.

METHODOLOGY
This is a prospective randomized controlled study, involving one hundred women
with singleton term pregnancy undergoing elective or emergency lower segment
caesarean section under spinal anaesthesia. They were randomly allocated to
receive either misoprostol (Emzor Beijing Zizhu Pharmaceutical Co., Ltd, Beijing
China) 600microgram sublingually or intravenous 10 units bolus oxytocin
(Rotexmedica Trittau, Germany) immediately after delivery of the baby. The
main outcome measures were blood loss at caesarean section estimated by the
senior anaesthetist who was blinded to the types of uterotonics used , pre and
post operative packed cell volume, need for additional oxytocics and drug related
side effects.
RESULTS
There was no significant difference in mean estimated blood loss in both groups.
Mean blood loss in oxytocin group was 544.0±144.5mls while in misoprostol
group it was 518.0±164.7mls with p value of 0.40. There was also no significant
difference in pre and post operative packed cell volume with p value of 0.094
and 0.49 respectively.

There were more women in the oxytocin group that require additional oxytocic.
The only side effect observed during the study was shivering, noticed in
misoprostol group (24%) while none was observed in the oxytocin group.

CONCLUSION
Sublingual misoprostol appears to be as effective as intravenous oxytocin in
reducing blood loss at caesarean section. Its use should therefore be encouraged
in setting where there might be difficulty in preserving oxytocin. However,
incidence of shivering was observed only in the misoprostol group.

RESEARCH ON ACTIVE MANAGEMENT OF THE THIRD STAGE AT CAESAREAN SECTION: SUBLINGUAL MISOPROSTOL VS INTRAVENOUS OXYTOCIN